Changes

Use Low Molecular Weight Heparin (LMWH)

Page Content

​Using low molecular weight heparin (LMWH) for prophylaxis and treatment of venous thrombosis offers many advantages over regular heparin. There is no need for use of intravenous pumps, collection and analysis of multiple blood samples for measurement of activated partial thromboplastin time (aPTT), or dose adjustments and manipulations. Eliminating the need for these processes significantly decreases the risk of errors and adverse events. Further, patients can be discharged with LMWH while they are being converted to Coumadin for long-term anticoagulation therapy, which shortens their hospital stay.

Tips

Watch out for patients who should not receive LMWH, such as those with poor renal function.

Remember that dosing is different for prophylactic use of LMWH than for therapeutic use.

Use caution with computerized systems, as they may not alert you when both LMWH and regular heparin have been ordered. For example, when regular heparin is ordered upon a patient’s arrival in the Intensive Care Unit, it may not be obvious from the patient’s computer record that another form of heparin, LMWH, has already been administered to the patient in the Emergency Room.

Remember that platelet counts should still be monitored with LMWH, just as with regular heparin.

Be sure staff are trained and understand reversal of LMWH.

Implement a procedure to ensure that patients who have had spinal anesthesia do not receive LMWH, at least not for a specified time after the procedure.

This IHI Innovation Report discusses key reasons why current efforts to reduce prescription opioid use and misuse in the US have thus far been largely ineffective in stemming the crisis; highlights gaps in current efforts that underscore the need for a coordinated and collaborative community-wide approach; identifies four primary drivers to reduce opioid use; and proposes a high-level construct for a system approach at the community level to address the US opioid crisis.